Our approach to management of patients with pulmonary vein stenosis following AF ablation

Despite advances in the approach to pulmonary vein isolation, pulmonary vein stenosis remains an important morbid complication affecting approximately 1.3% of procedures. Patients with symptomatic pulmonary vein stenosis are typically referred for intervention with either balloon angioplasty or stenting. A significant portion of patients with severe pulmonary vein stenosis are asymptomatic and are identified only if routine screening is preformed following ablation. Based on available evidence, CT scanning 3 months postablation appears to be an effective and reliable screening tool that can be used to identify asymptomatic patients with significant stenosis. The best clinical management for asymptomatic patients with severe stenosis is poorly defined. We typically refer these patients for pulmonary vein intervention; however, the patient's age, comorbidities, functional capacity, as well as the size of the pulmonary vein affected, all need to be carefully considered with the patient before proceeding.